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Congenital

Congenital Defects

QuestionAnswer
FWS or FUO? Get baseline labs FUO - shotgun approach
"FWS or FUO? No baseline labs, except an occasional UA" FWS
FWS or FUO? Admission is like3ly and needed FUO
FWS or FUO? No empiric antibiotics Both FWS and FUO. Exception is if a kid looks sick and has FUO
FWS or FUO? Empiric antipyretics FWS
"The Sepsis Infection Response Syndrome (SIRS) is better 4 dxing adults than peds, so I will not write questions about them" FYI
SIRS due to infection is called sepsis
SIRS with one or more end organs compromised is called severe sepsis
Severe infection resulting in systemic hypOtension is called septic shock
Most common cause of sepsis in neonates Group B Strep
3 most common causes of sepsis in neonates "Group B Strep, E. Coli, Listeria"
Most common causes of sepsis in infants and toddlers is… Pneumococcus. H. flu. and gram neg rods like E Coli
How do you dx sepsis? clinically. Child will appear toxic
"What major systems are affected in a ""toxic"" child?" "CNS, CV, Resp, Renal (or anything that indicates END ORGAN DAMAGE)"
What CNS signs indicate that a child is toxic? "Abnml alertness, poor eye contact, inconsolable crying"
What CV signs indicate that a child is toxic? "Tachycardia, hypotension, poor capillary refill, cyanosis"
What respiratory signs indicate that a child is toxic? hyperventilation leading to hypoventilation
What renal signs indicate that a child is toxic? poor urine output
"If a neonate or infant <3mos has left the hospital and appears septic, what labs should you draw to evaluate?" "CBC, BC x 2, UA & UC, chem7 in all patients. LP is suspected meningitis. CXR if aqbnl lung exam"
Treatment for sepsis requires hospitalization for close monitoring and early aggressive IV abx use to tx the cause. What abx should you use in neonates? Children? NEONATES: Amp/Gen. Children: Cefoxitin or Rocephin
What are the MC causes of septic meningitis in neonates? (clue: it's the same as sepsis) "GBS, E. coli, Listeria "
What are the MC causes of septic meningitis in infants? (clue: two are the same as sepsis +1) "H. Flu, Pneumococcus, N. meningitidis"
What organism is known to cause septic meningitis in neonates and teens? Chlamydia trachomatous
What are the MC causes of aseptic meningitis? "Viruses (ie Enterovirus, HSV, and arbovirus (rare)"
"Other than viruses, what else can cause aseptic meningitis in children?" "Fungal, parasitic, and TB"
It's very rare to have meningitis without (write in)… fever
What are common S&S of meningitis? "fever, AMS, HA, neck pn, progressive onset"
What might you find on exam of a child with meningitis? (Funky BB PP -- FTNK BB PP) "fever, toxic apperance, nuchal rigidity (not common in under 2yo), kernig's sign, brudzinski's sign, bulging fontanelles, petichiae or purpura"
Which organism can cause septic meningitis that can take a child from slightly ill to dead in hours? N. meningitidis
Which type of meningitis can cause purpura and may cause death even after treatment? (write in) meningococcal meningitis
What lab values are consistent with meningitis? "Leukocytosis with neutrophilia on CBC, LP with an opening pressure >20 cm H20"
What should you do before a lumbar puncture (especially if noted papilledema or focal neurological signs)? CT
"WBC/cc of 1-50,000 indicate what type of infection?" bacterial
"WBC/cc of <1,000 indicate what type of infection?" viral
WBC/cc of <500 indicate what type of infection? TB
"If the lab comes back with a positive gram stain or culture, what type of organism is likely to cause the infection?" bacterial
"What pathology presents like meningitis, but often has focal deficits, seizures and mental status changes?" encephalitis
"What pathology presents like meningitis, but often has focal deficits, and can only be diagnosed on CT?" CNS abscess
What abx do you use to treat meningitis in neonates? In infants/children? NEONATES: Amp/Gen. Children: High Dose Rocephin
What general tx methods should you use to treat meningitis? "Aggressive abx, Hospitalization (possibly ICU), IV hydration and antipyretics"
How can you prevent meningitis for those who are NOT close contacts? What about those who are? Meningococcal vaccine for all children at 11-12 yo and all adolescents going to military or dorm // CLOSE CONTACTS: Rifampin for 2 days
What type of organisms most commonly cause encephalitis? "viruses (ie Enterovirus, HSV, and arbovirus"
This type of encephalitis presents similar to multiple sclerosis "Acute disseminated, encephalomyelitis (ADEM)"
What do you need for a definitive dx of encephalitis? EEG or neuroimaging
ADEM usu responds to… steroid
HSV encephalitis usually resolves with acyclovir
What are the two main types of bacteremia? "source (eg pneumonia, cellilitis, etc) and occult (hidden causes ie UTIs)"
Created by: 630576651